Individual health record system and apparatus

ABSTRACT

A system, apparatus, and related methods for the collection, processing, evaluation, transformation, and reporting of individual health care information from diverse information systems and sources. A individual health record (IHR) of the present invention provides a structure for individuals to participate in, and manage, their health and their medical care, while still meeting the needs of health care organizations and caregivers. An IHR object may be formed by obtaining information from diverse health care information systems and sources, and transforming and re-purposing into a coherent account of the individual&#39;s overall health and care using a comprehensive health care ontology. As information from various sources is updated or available, the IHR is dynamically updated on a continuous or periodic basis. In one embodiment, the IHR system is contained in a self-contained package or “appliance” designed to “plug and play” in existing health care information technology systems and networks, with minimal effort and intervention.

This application claims benefit of U.S. Provisional App. No. 60/826,967,filed Sep. 26, 2006, by Ralph A. Korpman, et al., and is entitled tothat filing date for priority. The specification, attachments, anddrawings of the above application are incorporated herein by specificreference.

FIELD OF INVENTION

This invention relates to a system, apparatus, and associated methodsfor the collection, processing, evaluation, transformation, andreporting of individual health care information from diverse informationsystems and sources.

BACKGROUND OF THE INVENTION

Most information technology (IT) applications are built on predefining,with great specificity, the types and construction of information to bereceived, sent, processed, and stored by the IT service or application.For many industries, this model works fairly well. In the health careindustry, this model may work passably well when the application is usedin operating a particular institution or practice where the relevantinformation is fairly limited, and can be specifically defined,collected, and managed. Even in such limited circumstances, however,such applications have problems because of the inherent randomness inbiologic functions. This inherent unpredictability of biologic functionsmeans that an individual's health does not follow a predefined course,making it a particularly difficult automation challenge.

This model does not work well for an individual-centric approach tohealth care. Health care is transforming from a traditional,provider-centric, organizational-driven approach to anindividual-centered system. This individual-centered approach cutsacross all providers and patients, and the interrelationships of sourcesof information cannot be predicted in advance. In addition, theinformation and relationships will vary widely from person to person,place to place, and time to time. Furthermore, because a broad range ofpatients, practitioners, and other health care stakeholders will beaccessing and using the information for a variety of purposes, not onlyare the sources not predefined, but uses of the information are notpredetermined either. Attempting to create a comprehensive, workablesystem for handling individual health care records using current modelsresults in enormous, unwieldy databases and applications that areexpensive and slow to operate and maintain, and prevent such systemsfrom fulfilling their functions.

Accordingly, what is needed is a new model and approach to creating andmaintaining individual health records that is robust and flexible enoughto handle health information from a wide variety of unpredictablesources, and permits a broad range of patients, practitioners, and otherusers to manipulate and use health information in a wide variety ofunpredictable ways.

SUMMARY OF THE INVENTION

The present invention is a system, apparatus, and related methods forthe collection, processing, evaluation, transformation, and reporting ofindividual health care information from diverse information systems andsources. Health care is transforming from a traditional,provider-centric, organizational-driven approach to anindividual-centered system. The individual health record (IHR) of thepresent invention provides a structure for individuals to participatein, and manage, their health and their medical care, while still meetingthe needs of health care organizations and caregivers, therebysupporting collaborative care in a new way.

The IHR is formed by obtaining information from diverse health careinformation systems and sources, including, but not limited to, existingsystems and information flows such as employee health records,pharmacies, laboratories, and medical claims information streams. Theinformation from these sources is transformed and re-purposed into acoherent account of the individual's overall health and care. The IHR isnot a simple collection of all health care information about theindividual; instead, the information is processed by means of anindividual health information model that incorporates a comprehensivehealth care ontology.

In one exemplary embodiment, information is received from a source,validated, parsed, transformed, matched to an existing individual, andassigned an ontology concept code. Next, a message object is created,the data is repurposed, subjected to a rules evaluation, and filed in anIHR database. As information from various sources is updated oravailable, the IHR is dynamically updated on a continuous or periodicbasis. A Single Best Record (SBR) of information may be created.

In other exemplary embodiments, the invention provides ways and means tointeract with the information in the IHR in a variety of ways, includingthrough health portals, portlets, and web services. It allowsindividuals to understand and participate in their health care, andenables caregivers and consumers to collaborate and interact using thesame record in different ways. It embraces the emerging roles ofcustodian and health care advocate, and assists health carestakeholders, including but not limited to health systems, health plans,IPAs, RHIOs, employers, providers, and individuals, to meet therequirements and needs for health care systems going forward into thefuture. In one exemplary embodiment, the present invention does notreplace existing information systems and infrastructure; instead, itprovides a standards-based, service-oriented infrastructure that rapidlyand easily provides health-related information and components that workwith such existing systems.

In another exemplary embodiment, the IHR system is contained in aself-contained package or “appliance.” The IHR appliance is designed to“plug and play” in existing health care information technology systemsand networks, with minimal effort and intervention. Information isobtained from all available source systems and dynamically constructedinto the IHR.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is an overview of an IHR system in accordance with one embodimentof the present invention.

FIG. 2 is a diagram of customer portlets in a customer portal inaccordance with an embodiment of the present invention.

FIG. 3 is another view of an IHR system in accordance with oneembodiment of the present invention.

FIG. 4 is yet another view of an IHR system in accordance with oneembodiment of the present invention.

FIG. 5 is another view of an IHR system showing a customized applicationof an IHR system in accordance with one embodiment of the presentinvention.

FIG. 6 is a diagram of data flows in accordance with one embodiment ofthe present invention.

FIG. 7 is a message processing map in accordance with one embodiment ofthe present invention.

FIG. 8 is a diagram showing interface service processing in accordancewith another exemplary embodiment of the present invention.

FIG. 9 is a diagram showing merger of entities in accordance with anexemplary embodiment of the present invention.

FIG. 10 is a diagram showing the relationship of the ontology tool tothe IHR database in accordance with an exemplary embodiment of thepresent invention.

FIG. 11 is a diagram showing authorization rights components inaccordance with an exemplary embodiment of the present invention.

FIG. 12 is a schematic diagram of an example of individual's carerelationships.

FIG. 13 shows role-based user authorization security components inaccordance with an exemplary embodiment of the present invention.

FIG. 14 shows role-based user authorization security components inaccordance with an exemplary embodiment of the present invention.

FIG. 15 is a diagram showing elements of an appliance in accordance withan exemplary embodiment of the present invention.

FIG. 16 is a diagram showing elements of an application server inaccordance with an exemplary embodiment of the present invention.

FIG. 17 is another view of an IHR system in accordance with oneembodiment of the present invention.

FIG. 18 is yet another view of an IHR system in accordance with oneembodiment of the present invention.

FIG. 19 is a diagram of data flows in accordance with one embodiment ofthe present invention.

FIG. 20 is a message processing map in accordance with one embodiment ofthe present invention.

FIG. 21 is a diagram showing the relationship of the ontology tool tothe IHR database in accordance with an exemplary embodiment of thepresent invention.

FIG. 22 is a diagram showing elements of an appliance in accordance withan exemplary embodiment of the present invention.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

The present invention is a system, apparatus, and related methods forthe collection, processing, evaluation, transformation, and reporting ofindividual health care information from diverse and potentiallyunpredictable information systems and sources, which also allows a widevariety of patients, health care givers, practitioners, and other usersto manipulate and use the information in a variety of potentiallyunpredictable ways. The individual health record (IHR) system of thepresent invention provides a structure for individuals to participatein, and manage, their health and their medical care, while still meetingthe needs of health care organizations and caregivers, therebysupporting collaborative health care in a new way.

The present invention uses a new business object model approach, knownas Health Universal Genericity (HUG). This approach presumes thatreceived information can be represented by a handful of highlyabstracted health objects. These abstractions include, but are notlimited to, health events, health conditions, health services, healthproducts, and health relationships. Individual objects are created fromdata shared among these abstracted health objects through the uniqueinterplay of “data objects,” which exist only to hold data in support ofthe IHR-supported health delivery process. Each object's attributes area composite of specific variables defined in the object class, extendedby non-programmatically supported user-defined attributes.

In one exemplary embodiment, the IHR is formed by obtaining informationfrom diverse health care information systems and sources, including, butnot limited to, existing systems and information flows such as employeehealth records, pharmacies, laboratories, and medical claims informationstreams. The information from these sources is transformed andre-purposed into a coherent account of the individual's overall healthand care. The IHR is not a simple collection of all health careinformation about the individual; instead, the information is processedby means of an individual health information model that incorporates acomprehensive health care ontology.

The system of the present invention has several unique characteristicsthat distinguish it from prior art systems. First, the level ofabstraction is far higher than has been generally used in health care.High level abstract objects appropriate to each individual's health careare used, rather than the specific, detailed objects specific to eachcare setting used in the prior art. The use of these high level abstractobjects in the present invention allows broad adaptability andflexibility without the intervention of programming modifications andresources that would required to effect changes in other systems.Second, the extension of the object model by binding it to thecomprehensive health care ontology changes the meaning and use of thetraditional object paradigm. Third, the system can take potentially allinformation about an individual (including, but not limited to,clinical, financial, personal, health, and administrative information),and represent it in a single, unified fashion. The system thereby cantie together not only the matching clinical-to-clinical orfinancial-to-financial transactions, but transactions or interactionsacross these traditionally separate data streams as well. This presentsa uniquely robust view of each individual, his or her health carestatus, and the relationships of the health care system. Fourth, thesystem has the ability to extend the health objects, and their behavior,by modifying the ontology rather than the objects themselves. Thismodification can be done non-programmatically, thereby providingincreased installability and flexibility over the prior art. Fifth, thecreation of a health object from a metadata data object by the processof “centrification” (as discussed in more detail below) allows bothpreservation of the source information and simultaneous repurposing ofthe information to a uniform and unified representation. It should benoted that the system of the present invention does not use an XML-likeapproach, where data fields and their definitions are stored as pairsbut the underlying infrastructure knows nothing about either part; inthe case of the present invention the infrastructure is fully informedregarding both parts.

In one exemplary embodiment, the set of healthcare objects are unique,and allow virtually any health instance or activity to be characterizedand interrelated to other health information known about, or to be knownabout, about an individual. Each object may comprise methods,attributes, and inheritances.

FIG. 1 shows a broad, abstract view of an IHR system. The core IHRapplication 10 comprises the health data 12, connectivity services 14,and Internet Web services 16. Data is received from a variety of sourcesystems 20. A variety of different types of users can access the IHRsystem through customer applications 30 or customer portlets 32(described in more detail below). Customer portlets 32 may be used incustomer portals 34, as shown in FIG. 2.

FIGS. 3 and 17 show the IHR application 10 as an appliance installed ina customer's existing IT system behind a firewall 40. Information isreceived from a variety of source systems 20. Users include, but are notlimited to, public health entities 42, retail pharmacies 43, labs 44,and hospitals 45.

In one exemplary embodiment, as shown in FIGS. 4 and 18, the IHR systemcomprises a persistent data storage layer 200, with a full object model202 in the application layer supported by hibernate object andrelational mapping. Part of the persistence layer comprises a contentrepository 204 provides a storage mechanism for IHR content items, suchas binary large objects and other typically non-object oriented data(e.g., images, documents, rule definitions, message templates,information content, and help files), and may comprise standardizedtechnology (e.g., Java). Content attributes or meta data associated withcontent items may be used for management and selection of discretecontent items. Examples of attributes include, but are not limited to,ontology classes, target age, target gender, usage context, effectivetime, expiration time, keywords, status and location. The contentrepository may be viewed as a generic application data “super store,” inwhich virtually any type of content can be handled, and that separatescontent from data storage technology. Content may be XML exportable andimportable. A standard API (such as JSR 170 or JSR 238) may be used tointeract with a content repository, thereby providing advantages such asthe ability to access other standard content repositories, allowexternal editing, and transport content between Java contentrepositories.

The IHR Services layer 206 provides main IHR capabilities, including butnot limited to centification services, interaction services, custodialservices, and system administration services. Connectivity services 14provide interface means with source systems 20, and handle messages andrecord parsing. Connection adapters may be used. The web servicescomponent 208 provides external access by users to the IHR data andfunctions through a variety of portlets 32, which may include customerwritten applications. In one exemplary embodiment, web applications maybe instantiated as Java Specification Request 168 (JSR-168) or WebServices for Remote Portlets (WSRP) standard portlets. As seen in FIG.5, other applications 210 can call web services 208 to create acustomized solution.

FIGS. 6 and 19 show a general, broad overview of data flows inaccordance with one embodiment of the subject invention. Information anddata in the form of a “message” 52 (although some other form orterminology is possible) is received from a source 50, validated 54,parsed 56, and transformed 58. These steps are accomplished throughintegration services as part of the connectivity services 14. Thetransformed data is then matched 62 to an existing individual throughidentity management services 64, and assigned an ontology concept code66 (CHID, discussed below) through ontology services 68. Next, a messageobject is created 72, the data is repurposed 74, subjected to a rulesevaluation 76 using the rules engine 78, and filed 80 in a persistentIHR database 90. Some of these steps may be performed in another order,as shown in FIG. 19. The identity management services 64, ontologyservices 68, and rules engine 78 are components of the business processservices 70 element of the IHR system. As information from varioussources is updated or available, the IHR is dynamically updated on acontinuous or periodic basis.

The connectivity services 14 component handles the connections withhealth data source systems. In one exemplary embodiment, theconnectivity services uses an open-source cross-platform HL7 interfaceengine, although other platforms may be used. A connectivityconfiguration manager stores configuration data and manages thedeployment environments. The platform monitors and manages theconnectivity runtime components, including the connectivity designerused to define the specific message handling processes, connectivityadapters, and the runtime engine.

FIGS. 7 and 20 shows the message processing map for an exemplaryembodiment of the present invention. Two examples of source systems areshown: in FIG. 20, these are a Source system A 91 and a Source system B92. The data undergoes protocol 94 and envelope 96 processes, andundergoes transform processing 98. The data is mapped 102 and submittedto the interface schema filing queue 104. Additional interface internalprocessing is shown in FIG. 8.

In another exemplary embodiment, the present invention comprises aSingle Best Record (SBR). The SBR comprises a healthcare objectcontaining the “very best” composite information known about ahealthcare event, test, or the like. In current healthcare electronicrecords systems and operations, the systems rely on individuals toexamine large amounts of information about an individual patient (manyinstances of this information, in fact, referring to the same event),and then manually determine which portions of which instances should beconsidered relevant. For example, a mammogram might first be reportedvia an appointment request, then subsequently by a visit summary whenthe patient checks in, then a report of the exam several days later,then a claim submissions for payment, then the payment for the exam. Inprior art systems, these would be separate records and it would be up tothe user to glean the important information from each, even though theyall actually refer to the same actual event. The processes of the SBR ofthe present invention allow all of these records and data sources to beevaluated and properly combined into a single SBR object, containing the“very best” information known about the mammogram from all sources. Inshort, fragmented partial information about real world health events,received as information events, is reconstituted into a coherent accountof those real world events. The SBR object may then be instantiated intothe IHR system. Data received at a later time (whether a month, year, oreven later) can be subjected to the SBR process upon receipt,contextualized into the appropriate SBR object, and seamlessly made partof the individual's health record.

The SBR process operates by taking each data input as an “informationevent.” Information events do not necessarily have a one-to-onecorrespondence with real life events. Information events represent theway information about an individual can be received from any source atany time. From each information event, specific subsets of key healthdata are subjected to the SBR process (i.e., evaluated and combined intothe SBR object) to create or update the IHR system's knowledge about aparticular individual. This process could include, for example, updatinga service, a date, a condition, a product, a test, or the like. Eachinformation event may be compared to existing objects in the IHR systemto determine if the information event is describing a new health eventor is providing additional information on a known health event and if sowhether it is an improvement on what is already known. The SBR processthereby uniquely combines what is learned from external sources withwhat is already known about that health event or concept to delivercomposite information where previously there had only been fragmenteddata.

In some embodiments, a person SBR may be created, comprising a compositeset of the best demographic data the IHR system knows about an entity.Demographic data from each person data object (i.e., each event) is usedto update the person SBR.

In one embodiment, the IHR system is dependent on the ability toaccurately identify or create an entity, and link data correctly.Identity management services (IMS) 62 handle these functions. In anexemplary embodiment, two types of entities are of particularimportance: persons (including, but not limited to, patients, members,consumers, clinicians, and individuals), and organizations (including,but not limited to, employers, payors, and providers, such as hospitals,reference labs, imaging centers, or nursing homes). IMS functionsinclude creation, matching, merging, and unmerging for each type ofentity.

One goal of identity matching is to have the disparate data about anentity from multiple source be placed in or inserted into a singlerecord (e.g., the SBR). The persons and/or organizations within amessage or input data are matched to the persons and organizations knownto the IHR system (or creates a new record for the entity if nonepreviously exists). The identity matching process returns a CHID thathas been assigned to the entity. Alternatively, criteria matching can beused to effect a match. Criteria may comprise demographic information(e.g., name, birth date, gender, address, telephone number, emailaddress, mother's maiden name), identifiers (e.g., medical recordnumber, social security number, member number, provider ID, driver'slicense ID), or relationship information (e.g., family data, serviceprovider relationship). Probablilistic matching may also be used.

For criteria based matching, in one exemplary embodiment, a library ortable of matching criteria rules may be used. Rules may exist for personmatching, or organization matching. Each rule may comprise one or morecriteria which must be met to achieve a successful match. Rules may beelectronic system specific. As best practices are established, they maybe applied to other electronic systems.

If the system determines that no match exists, then the system maycreate a new entity record.

In one exemplary embodiment, all demographic source data is treated likeany other data object; any demographic source data received in amessage, form or web service input will create an event. This permitsthe system to display the demographic date in the relevant event, and beable to “rematch” the person and/or re-SBR as needed.

In another embodiment, when two entities 110, 112 are recognized by thesystem to be the same entity, they are effectively merged by creating athird entity 114, as shown in FIG. 9. The data and events from the twoentities are merged. Not only do events 116 point to the originalentity, but they also point to the new entity. New events need to beattached properly: new data is attached to the most specific (lowestlevel) entity, as well as higher level entities. Any new data generateddirectly by or on the merged entity will be attached to that entity.Merged entities may themselves be merged.

Conversely, entities may be unmerged (i.e., linked entities areseparated). Audit histories may be created for each entity involved inthe unmerged, and formerly merged entities can be accessed through theaudit history. In the unmerging process, any events on the merged entitymust be manually assigned to the appropriate lower level entity.

In yet another exemplary embodiment, the present system comprises aunique health ontology to overcome limitations of the prior art inrepresenting knowledge and information. A uniform and unifying way ofdealing with health information is highly desirable. Most prior artsystems contain some type of coding scheme, internal or external. Someof the more popular schemes include the Standardized Nomenclature ofMedicine (SNOMED), and ICD-9 or ICD-10 (the International Classificationof Disease, including the clinical modification variations). While thesecoding schemes have long been proposed as needed for health IT systems,and have been adopted and used by many systems, they have been usedprimarily in retrospective studies, and have not had the desired impacton real-time health delivery.

Ontology is a body of formally represented knowledge comprising a set ofconcepts, their definitions, and their relationship for a specificdomain (in this case, health and healthcare). The ontology of thepresent system is far more than a coding scheme; it not only is a way ofrepresenting every concept in health care, but also a way orrepresenting how such concepts interrelate for the purpose of supportingthe health care of individuals and the ways in which such concepts canbe referenced and invoked.

In one exemplary embodiment, the system's ontology services function byreducing each piece of received information to a centrified healthidentifier (CHID). Each CHID has both relationship and attributeinformation, allowing it to know far more about the meaning of thatisolated piece of information in relation to the individual than justthe information received. For example, a C-section is not just asurgical procedure. There are a number of “knowledge concepts” that canbe inferred by virtue of the fact that a patient has had a C-section.The various health care coding schemes that are available with regard toany particular patient may relate not only to the C-section but,perhaps, to other findings related to a C-section. Theseinterrelationships are represented in the ontology, so that the universeof issues and findings to be associated with such a patient becomes partof the inherent knowledge used and conveyed by the subject invention.For instance, if it is known that an individual has a C-section, theontology also informs the system that the individual is a female, hasbeen pregnant (gravida >0), and has had a non-vaginal delivery of afetus or a child, among other things. As another example, the structureand content of the ontology means that an elevated Hemoglobin AICinforms not only that the person has diabetes, but also the inheritanceof an entire class of characteristics of people that have diabetes.

The ontology is “full of” attributes that identify characteristics of agiven concept, including but not limited to how it is displayed, whereit is displayed, and what privacy and confidentiality treatments apply.Data may be stored both as original source vocabulary code, and as IHRconcept code (e.g., CHID).

In one exemplary embodiment, the ontology of the present inventioncomprises over 1,500,000 source vocabulary terms, referencing over300,000 distinct concepts represented as CHIDs. There are a largeplurality of linkages among the CHIDs and the concepts that can becomemore mature and meaningful as additional use cases are examined andincorporated into the system. Concepts can be mapped bidirectionally toand from various source vocabularies. This representation of informationallows operations not possible in the prior art. As a nonlimitingexample, patients and caregivers can have the benefit of the effectiveapplication of rules-based care algorithms (such as are putativelyapplied by disease management companies) in real time, as opposed to thedelayed, after-the-fact interventions that are usually applied byquality monitoring and disease management companies.

In another exemplary embodiment, ontology web services identify anddeliver the appropriate concept from the IHR system ontology. Examplesof methods used by ontology web services include getCHID (used when aforeign key is passed in order to retrieve a mapped CHID), getForeignKey(used when a CHID is passed in order to retrieve a mapped foreignconcept ID), getName (used to retrieve a system controlled medicalvocabulary concept term), and getForeign (used to retrieve a foreignvocabulary concept term).

In exemplary embodiments, the use of the ontology to cross all sources,uses, and users of data to provide an individual-centric view and tosupport the determination of the proper single best record is unique.

Another goal of the ontology is to enable data in the IHR system to“interoperate” using rules that create alerts and reminders, update theindividual's health status, monitor health action progress, and similaractivities. To achieve this, the data in the IHR system must be coded,have context and meaning, be linked to content, and be comparable (asseen in FIGS. 10 and 21). Benefits gained from this system are improvedinteroperability, increased user adoption, better clinicaldecision-making, reduction of medical errors, improved data mining, andthe support of better outcomes analysis, among others.

Source vocabularies include a number of code systems and sets. Theseinclude, but are not limited to, the following: ANSI X.12 (standard fordefining electronic data exchange of healthcare administrativetransactions); ANSI HL-7 versions 2 and 3 (standards for the exchange,management and integration of electronic healthcare information); CPT(Current Procedural Terminology); HCPCS (Healthcare Common ProcedureCoding System); ICD-9-CM and ICD-10 (International Classification ofDiseases and Procedures); ISO (Internal Standards Organization); LOINC(Logical Observation Identifiers, Names and Codes); NACIS (NorthernAmerican Industry Classification System); NCPDP (script ePrescribingstandard); NDC (National Drug Codes); NUBC (National Uniform BillingCode); RxNom (nomenclature for clinical drugs); and SNOMED CT(Systematized Nomenclature of Medicine). Proprietary code sets fromsource systems may also be used as needed.

In one exemplary embodiment, a central ontology may be maintained andupdated on a continuing basis by a service provider. When significantchanges are made, the updated ontology is released. Custodians andhealth advocates may be able to make local extensions to their ontology.

In another exemplary embodiment, the system comprises a connectivityapplication module that supports the IHR system approach of taking datafrom any authenticated source at any time. The connectivity applicationmodule receives, understands, and processes data, information andmessages regardless of the type, allowing almost any type or kind ofsource to provide information to the IHR system. In one exemplaryembodiment, information from over 150 sourcing systems can beincorporated in a particular installation of the IHR system. The numberof sourcing systems is unlimited.

In yet another embodiment of the IHR system, the presence ofunderstandable and understood data in the system provides theopportunity to patients, caregivers, and other users to actually use thedata for a wide variety of uses and applications. Such uses include, butare not limited to, quality enhancement (e.g., duplicate blocking,interaction detection and resolution, real-time adherence to diseasemanagement and other protocols, and best practices enforcement), andefficacy/efficiency optimization. Many of these uses and applicationsmay be accomplished through a rules detection and execution environment,which may be seamless incorporated into the IHR system to provide aheretofore unavailable level of rules integration.

The IHR rules environment follows the objects created for the systemusing fully ontologized data. Each time an object is created ormodified, all applicable rules are evaluated to see if particularcriteria are met. The process includes, but is not limited to, theupdating of all status indicators, and the sourcing and scheduling ofrules involving time-dependent criteria (e.g., one mammogram per yearfor females over 40). Accordingly, in one exemplary embodiment, withevery data creation or modification event, and with every tick of theclock, the potential exists for rules to execute. Rules also can triggerother rules, supporting the complexity of the health delivery system asit actually works.

An individual's health status indicators thus may be as up-to-date asthe data received into the IHR system. Whenever new data is added to anindividual's IHR (or data is modified), rules are evaluated. A rulescheduler may also be used and an object may schedule itself at specificfrequencies. The scheduler executes rules evaluation for time-dependentcriteria. This may include age-dependent rules. Kick-off notificationsmay be given at appropriate times prior to health action due dates aswell.

In general terms, the IHR system may use rules to categorize individualsand users, update and notify users of the individual's health status,generate health maintenance actions, process action plans, create datafrom other data, perform data entry business logic, protectivemonitoring, data entry edit checks, select appropriate CHIDs, the flowof applications, support subscription-publication services, and presentpersonalized content. Nonlimiting examples of rule applications also mayinclude the following: create health issue objects; create healthservices objects; update status; update an action plan; trigger a securemessage; trigger a reminder; invoke a content display; list an entry;send a message to an external system; send a fax; supplement a list; andadd to the health calendar.

In one exemplary embodiment, business rules are managed independently ofapplication code changes. Non-programmers may be provided with theability to create and change rule. This ability may be provided throughadd-on decision table support. Multiple rule types may be supported, andan audit trail of rule changes may be maintained.

Decision tables may be used to represent conditional logic. Spreadsheetprograms may be used to set up rules. Rule creators can defineparameters while scripts that map the rule data to the underlying objectmodel are hidden.

When a rule is true, an action is triggered. Actions may include, butare not limited to, the following: creation of health issue objects;creation of health service objects; update status indicator; updateaction plan; secure a message; reminders; content display; list entry;health calendar entry; send a message to an external system; or send afax.

Another exemplary embodiment of the present invention comprises arepurposing object program (ROP). The ROP overcomes a fundamentallimitation of many prior systems where the early delineation of whateach data item is for, and why, forever pigeonholes each data elementreceived. In the IHR system, the data received by the system can be usedfor a variety of purposes, many originally contemplated when the systemwas assembled. The ROP, in conjunction with the above features, resultsin a system allowing repurposing of the data.

The combination of the above processes and components results in aprocess known as centrification. The centrification process takesfragmented, poorly formatted, and often incomprehensible health caredata, and turns it into useful, individual-centric health careinformation.

In one exemplary embodiment, the conceptualization, design, development,and implementation processes that have resulted in the ontology withspecific reference to health care, have been generalized and appliedthroughout the entire system. Some or all of the application constructs(such as, but not limited to, the display and rendering models, labels,input fields, and content managers) are codified, allowing them to becontrolled non-programmatically.

In yet another embodiment, the IHR system uses a meta-data contentcontrol model which allows content from a plurality of streams andsources to be matched, displayed, and linked with appropriate keysprovided through the ontology or other IHR system services. Thisprovides a level of personalization with regard to content display toboth individual and professional users that is not present in the priorart.

In another exemplary embodiment, the IHR system comprises securitycustodial services. Prior art security models are premised on having aknown, predictable pattern of system use, user types, and data-allinstalled in an environment where certain limitations can be imposed byand on the data custodian. In addition, security models in the prior artare too structured and rigid to work in an environment where manyclasses of users use the same record for different purposes. Incontrast, the IHR system recognizes that neither the amount ofinformation to be secured nor the level of detail can be presumed inadvance. The IHR system is designed to deal with a variety of users,including, but not limited to, the following: patients; consumers; userswho delegate their security to a custodian; and to users who come and goon the system with a need for auditing oversight but not for directcustodial intervention. The IHR system is fully adaptive: in each case,services evaluate what data to secure, what is known about the entitieswith potential access to this data, and what the outcome of thecombination should be. As shown in FIG. 11, the authorization rightscomponents may comprise scope access, operations access, and data accesselements.

In an exemplary embodiment, data access depends on the class of data,which can include protected health information, sensitive healthinformation, and authored protected health information. Protected healthinformation (PHI) is used herein to refer to information that relates tothe past, present, or future physical or mental health or condition ofan individual, the provision of health care to an individual, or thepast, present or future payment for the provision of health care to anindividual, and that identifies or could reasonably be used to identifythe individual. Sensitive PHI is used herein to refer to PHI thatpertains to (i) an individual's HIV status or treatment of an individualfor an HIV-related illness or AIDS, (ii) an individual's substance abusecondition or the treatment of an individual for a substance abusedisorder, or (iii) an individual's mental health condition or treatmentof an individual for mental illness. Authored PHI is informationauthored by a particular user as an event initiator or performer. Invarious exemplary embodiment, the treatment of individual health datacomplies with all regulations and laws, including but not limited toHIPAA.

In one exemplary embodiment, the IHR custodial services comprise asecurity architecture based on relationships that the IHR system knowsand/or can infer between and among entities. What an IHR system user canaccess, called “scope,” is dynamically redefined as more and more datais known about an individual. As data is received from messages andother sources, including but not limited to direct data entry or networkor Web service interactions with source systems, the relationshipsbetween entities are gleaned, codified, and used to maintain the bestknown information about that relationship. So, all of the relevantconnections are recorded and summarized into the SBR of eachrelationship.

When a user accesses a IHR system access point, such as a healthportlet, the scope defined in the user's set of rights is evaluated.When the user performs an operation, only the data and information ofthe health records that match the relationship parameters are returned.

Scope access is based on the user's relationship to the individual. Anexample of an individual's care relationships is shown in FIG. 12. Onlyusers with a “legitimate relationship” with the individual will haveaccess to records concerning the individual. In one exemplaryembodiment, a legitimate relationship in the IHR system is a healthrelationship.

The security architecture comprises a number of other unique custodialservices. Prior art systems often overlook that in health systems,security should be performed at the data element level, not the recordlevel, and thus either restrict complete access to a patient's data, orrestrict access to a complete class of patient information (e.g.,insurance information). What is needed is the ability to restrict to anyelement (e.g., medical concept) of patient information. The IHR securityarchitecture is able to restrict around particular concepts or CHIDs, orthe values of a field or data element, or some combination thereof. Thispermits the system to restrict access or the display of any attribute ofan object based on the attributes of a CHID (or other value) defined inthe ontology.

In yet another exemplary embodiment, as seen in FIGS. 13 and 14, the IHRsystem comprises a multi-tiered, non-hierarchical ability to restrictaccess or display based on the role of a user. Role refers to thefunction or responsibility assumed by a person in the context of ahealthcare event. Role information documents a person's association withan identified healthcare activity. Roles include, but are not limitedto, provider roles (e.g., admitting, attending, billing, consulting,collaborating, interpreting, performing, referring, servicing,supervising, treating), personal roles (self, next-of-kin, emergencycontact, guarantor, guardian), or organization roles (carrier, employee,employer, insured, subscriber). A user can have multiple roles 120, 121,122, and each role can have specific rights 124, 125, 126, 127associated with it. When the user's role or “hat” changes, the user'sauthorization rights change. This include scope access rights,operations access rights, and data access rights. Thus, for example, adoctor in his or her practice has different access rights than the samedoctor looking at his or her own records, or the same doctor acting as ahealth insurance company review physician. Similarly, an individual maygrant or restrict access to any or all portions of their IHR from anyand all caregivers, based on a class of information (including sensitivepersonal health information, such as, but not limited to, psychiatricinformation, substance abuse information, HIV status, AIDS data, and thelike). Authorized users may “break the seal” on restricted informationin emergencies if that is the appropriate disposition.

The present invention provides a variety of ways and means to interactwith the information in the IHR, including, but not limited to, throughhealth portals, portlets, and web services. Thus, the invention providesa complete suite of information services and not just an end-userapplication. This allows the invention to support existing informationsystems in ways that previous “records” art could not. In one exemplaryembodiment, Java standard portlets and web services are used to delivera user interface (and user interaction) through a standard portal. Aportal is a Internet based application, and serves as a starting pointor gateway to other resources or applications. Portlets are userinterface components or modules for a portal. Traditionally, portletswere custom applications for specific portals, although recently,portlet standards (such as JSR 168) have been defined. All interactiontakes place via a communications chain extending from the portal througha portlet through the Internet service through the IHR applicationserver. This system promotes flexibility and broad, cross-platformubiquity in terms of accommodating users.

Connections between the IHR system and IHR portals and portlets may beencrypted. In one exemplary embodiment, a standard Internet Web browseris used to access the portal and portlets, and the connections are128-bit SSL-encrypted connections. In addition, the support connectionto all custodial sites will be via a VPN using encryption and othersecurity mechanisms to ensure that only authorized users can access thenetwork, and that data cannot be intercepted.

Administrative services include the backing up of various components ofthe system, including but not limited to database files and journalqueues. Backup may be performed in stages, with frequent backups tointermediate storage, and less frequent backups to long-term storage.Disaster recovery operations and fail-over database servers also may beused for data and system security and continued operations.

In an exemplary embodiment, the IHR system is bundled into aprepackaged, self-contained package or “appliance,” as shown in FIGS. 3,15, 17 and 22. The IHR appliance is designed to “plug and play” inexisting health care information technology systems and networks, withminimal effort and intervention. The appliance may be installed behind anetwork firewall. Information is obtained from all available sourcesystems and dynamically constructed into the IHR. This appliance modelfor an application level solution at this level is new, and provides theability to deliver any number of appliances and have them provide theIHR functions with minimal user intervention. In addition, this modelpermits appliances to be added to any node as necessary to deal withincreases in volume without major re-architecting of the solution or thenode. This allows rapid distribution and redeployment of IHR systems.

The IHR system thus allows individuals to understand and participate intheir health care, and enables caregivers and consumers to collaborateand interact using the same record in different ways. It embraces theemerging roles of custodian and health care advocate, and assists healthcare stakeholders, including but not limited to health systems, healthplans, IPAs, RHIOs, employers, providers, and individuals, to meet therequirements and needs for health care systems going forward into thefuture. In one exemplary embodiment, the present invention does notreplace existing information systems and infrastructure; instead, itprovides a standards-based, service-oriented infrastructure that rapidlyand easily provides health-related information and components that workwith such existing systems.

Operations available to users in various exemplary embodiments include,but are not limited to, identifying individuals, viewing an event list,filtering events, detailing events, editing events, printing events,viewing event details, managing users (e.g., adding users, editingusers, editing user fields, deactivating users, identifying users),identifying individuals, and manipulating health issues (e.g.,filtering, viewing list, viewing detail, adding, editing, and printinghealth issues).

Thus, it should be understood that the embodiments and examples havebeen chosen and described in order to best illustrate the principles ofthe invention and its practical applications to thereby enable one ofordinary skill in the art to best utilize the invention in variousembodiments and with various modifications as are suited for particularuses contemplated. Even though specific embodiments of this inventionhave been described, they are not to be taken as exhaustive. There areseveral variations that will be apparent to those skilled in the art.

1. A system for processing, storing and handling health careinformation, comprising: a persistent data storage device; aninformation input component, adapted to receive health care informationfrom one or more health care information sources; a central healthrecord component, adapted to create or modify abstract health careobjects from that information; and a user interface component, adaptedto provide access by one or more users to the system.
 2. The system ofclaim 1, further comprising a content repository for the storage ofnon-objected oriented data.
 3. The system of claim 1, further whereinusers can access the user interface component through one or moreportlets or portals on the Web.
 4. The system of claim 1, furtherwherein users can access the user interface component through anInternet Web browser.
 5. The system of claim 1, further wherein thecreation or modification of health care objects comprises the processingof the information using a health care ontology.
 6. The system of claim1, further wherein the information received may include clinical,financial, personal, health, or administrative information, or somecombination thereof.
 7. The system of claim 5, further wherein thehealth care objects can be modified or extended by modifying theontology.
 8. The system of claim 7, wherein the modification is donenon-programmatically.
 9. The system of claim 1, wherein the componentsof the system are contained in a single appliance device, said appliancedevice adapted to be incorporated into an existing network orinformation technology system.
 10. The system of claim 9, whereinmultiple appliance devices can be incorporated into an existing networkor information technology system.
 11. The method of claim 1, furtherwherein the step of transforming the information comprises theprocessing of the information using a health care ontology.
 12. A methodfor handling and transforming health care data, comprising the steps of:receiving information relating to health care about an individual fromone or more health care information sources; and integrating theinformation; identifying the information; and transforming theinformation into one or more abstract health objects regarding theindividual, where the objects need not be specific to a particularhealth care setting.
 13. The method of claim 12, further comprising thesteps of: applying rules to the transformed information; and filing thetransformed information into a database.
 14. The method of claim 12,wherein the step of integrating the information comprises the steps of:validating the information; parsing the information; and transformingthe information.
 15. The method of claim 13, wherein the step ofidentifying the information comprises attempting to match the entitycorresponding to the information with an entity with information alreadyin the database.
 16. The method of claim 12, further comprising the stepof repurposing the information.